Brief Article
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World J Orthop. Jan 18, 2013; 4(1): 24-28
Published online Jan 18, 2013. doi: 10.5312/wjo.v4.i1.24
Finger movement at birth in brachial plexus birth palsy
Rahul K Nath, Mohamed Benyahia, Chandra Somasundaram
Rahul K Nath, Mohamed Benyahia, Chandra Somasundaram, Research Division, Texas Nerve and Paralysis Institute, Houston, TX 77030, United States
Author contributions: Nath RK designed the study, and performed the surgeries; Benyahia M and Somasundaram C analyzed the data, and wrote the paper; all the authors revised and approved the manuscript.
Correspondence to: Rahul K Nath, Institute Director, Research Division, Texas Nerve and Paralysis Institute, 6400 W Fannin Street, Suite 2420, Houston, TX 77030, United States.
Telephone: +1-713-5929900 Fax: +1-713-5929921
Received: June 20, 2012
Revised: December 8, 2012
Accepted: December 15, 2012
Published online: January 18, 2013

AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury.

METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head (PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient’s parent or guardian during the initial evaluation.

RESULTS: Among 87 patients, 9 (10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion < -12°, whereas only 1 patient (1.1%) with finger movement had a PHHA > 40%, and retroversion < -8° in study 1. The improvement in glenohumeral deformity (PHHA, 31.8% ± 14.3%; and glenoid retroversion 22.0°± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth (group 1), when compared to those patients, who had primary surgeries (nerve and muscle surgeries), and lacked finger movement at birth (group 2), (PHHA 10.7% ± 15.8%; Version -8.0°± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study group.

CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.

Keywords: Finger movement, Triangle tilt surgery, Brachial plexus birth palsy, Glenohumeral dysplasia, Pejorative sign